An 82-year-old woman was given emergency admission because of severe anterior chest pain. We found an ascending aortic aneurysm 60mm in diameter. CT revealed acute aortic dissection with an ascending aorta. Emergeny operation was performed under a diagnosis of type-A acute aortic dissection with ascending aortic aneurysm. Operative findings showed thrombus in the dissection and a dilated ascending aorta without intimal tears. Operative findings differed from those of a classical dissection and were compatible with a diagnosis of aortic intramural hematoma (IMH). We performed hemi-arch replacement for the ascending aortic aneurysm under deep hypothermic cardiac arrest and she was discharged without any complications. IMH in the presence of coexisting ascending aortic aneurysm is extremely rare and we therefore reported the surgical repair of this rare case.

A 77-year-old man with an abnormal shadow on chest x-ray film, was found to have Kommerell's diverticulum associated with a right aortic arch 2 years previously. During the period of follow-up, the Kommerell's diverticulum was expanded to 5.3 cm in diameter. CT revealed a right aortic arch with mirror-image branching and Kommerell's diverticulum. To eliminate the risk of rupture, the Kommerell's diverticulum was excluded by deployment of a handmade fenestrated stent-graft using the brachial wire traction technique via the right femoral artery and left brachial artery. At 30-months of follow-up the patient is doing well, with no signs of endoleak or migration. Endovascular repair of Kommerell's diverticulum with a right aortic arch is feasible, safe and effective. This is a rare case of a right aortic arch with Kommerell's diverticulum and without left aberrant subclavian artery.